Medically assisted sex, or sex surrogacy, can help people with physical or intellectual disabilities have fulfilling sex lives.

Do you consider sex a human right? In the able-bodied world, the issue hardly comes up, but it’s a hot topic in the disability rights community. It has also recently emerged in mainstream political discussion after a controversial interview last week in Germany’s Welt am Sonntag newspaper. In it, the spokeswoman for the Green Party of Germany said that she could support a policy which would allow disabled people to claim sex with sex workers as a medical expense. Because the German government subsidizes and mandates a universal, multipayer health care system, some sex work could be subsidized by taxes.

This is a highly contentious issue and has galvanized conservative Germans who are morally opposed to sex work. A parallel issue has been the overwhelming influence of societal ableism which sees people with disabilities as childlike, without the ability to be sexual. Sex workers who act as sex surrogates have special training in how to assist and communicate with their clients. This is not a new phenomenon: back in 1990, disability rights activist Mark O’Brien published an article on seeing a sex surrogate, which was turned into the award-winning film The Sessions. In his writing, he describes how the desire to have sex coupled with his inability to express himself sexually lead him to live with a huge amount of fear and shame.

The German disability rights organization MyHandicap describes sex as a basic human right and discourages referring to this kind of sex as prostitution. In the disabled community, the concept of “skin hunger” is well known and discussed often. The idea behind it is that after the prolonged absence of meaningful touch, people become depressed and withdrawn. Some people with severe physical disabilities are only ever touched by their caregivers performing routine tasks. Medically assisted sex, or sex surrogacy, can help people with physical or intellectual disabilities have fulfilling sex lives. The sex surrogate could be their primary sexual partner or, in some cases, can serve as a caring, trained and knowledgeable first sexual partner to give the client the confidence to pursue a sex life outside of surrogacy.

At the heart of this debate is that idea that a sex life is a basic human right. That is often challenged by critics because a lack of sex doesn’t lead to death or any kind of irreversible physical damage. Still, the opportunity to engage with another person sexually can be emotionally healing. Regular sexual release can help with spasms and stiffness in people with cerebral palsy, but the benefits for other disorders aren’t known since there is relatively little research into disability and sex. For people who need professional to help them have sex, a single appointment can represent months of saving. Having this service subsidized by health insurance would allow for more disabled people who desperately seek a sex life to have safe, therapeutic access to it.

Right now, the Netherlands and Denmark have systems which allow for medically assisted sex to be covered by government health insurance. Taxpayers, though, baulk at the thought of paying a sex worker’s wages and so the proposal remains deeply divisive.

The tragic reality is that there may need to be research into the medical benefits of sex before more governments consider making sex surrogacy a service that is covered by national insurance.